Randomized Clinical Trial of Prevention of Hydrocephalus After Intraventricular Hemorrhage in Preterm Infants: Brain-Washing Versus Tapping Fluid

Whitelaw, Andrew; Evans, David; Carter, Michael; Thoresen, Marianne; Wróblewska, Jolanta; Mandera, Marek; Świetliński, Janusz; Simpson, Judith; Hajivassiliou, Constantinos A.; Hunt, Linda; Pople, Ian

doi:10.1542/peds.2006-2841

Cited by 152 publications

(98 citation statements)

References 23 publications

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“…Thirty-five percent (12 of 34) of preterm infants in the DRIFT study had secondary IVH, compared with 8% (3 of 34) who received standard treatment. 71 These results differ from those of earlier Class II and Class III studies in which a decreased rate for the need for permanent shunt placement was reported when low-dose urokinase or fibrinolytic therapy with tPA was used for ventricular irrigation and clot reduction. 32,61,75,77 Reviews conducted by Whitelaw and Odd 74 have also revealed that intraventricular injection of streptokinase has not been shown to be beneficial.…”

Section: Nonsurgical Temporizing Agentscontrasting

confidence: 93%

“…71 DRIFT did not significantly reduce shunt surgery or death, but it was associated with an increased rate of secondary IVH (Table 3). 71 Forty-four percent (15 of 34) of infants in the DRIFT group died or required a shunt, compared with 50% (19 of 36) of infants who received standard treatment. Thirty-five percent (12 of 34) of preterm infants in the DRIFT study had secondary IVH, compared with 8% (3 of 34) who received standard treatment.…”

Section: Nonsurgical Temporizing Agentsmentioning

confidence: 97%

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Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants

ChouDhri

Limbrick

2014

PED

150

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Object The objective of this systematic review and analysis was to answer the following question: What are the optimal treatment strategies for posthemorrhagic hydrocephalus (PHH) in premature infants? Methods Both the US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words relevant to PHH. Two hundred thirteen abstracts were reviewed, after which 98 full-text publications that met inclusion criteria that had been determined a priori were selected and reviewed. Results Following a review process and an evidentiary analysis, 68 full-text articles were accepted for the evidentiary table and 30 publications were rejected. The evidentiary table was assembled linking recommendations to strength of evidence (Classes I–III). Conclusions There are 7 recommendations for the management of PHH in infants. Three recommendations reached Level I strength, which represents the highest degree of clinical certainty. There were two Level II and two Level III recommendations for the management of PHH. Recommendation Concerning Surgical Temporizing Measures: I. Ventricular access devices (VADs), external ventricular drains (EVDs), ventriculosubgaleal (VSG) shunts, or lumbar punctures (LPs) are treatment options in the management of PHH. Clinical judgment is required. Strength of Recommendation: Level II, moderate degree of clinical certainty. Recommendation Concerning Surgical Temporizing Measures: II. The evidence demonstrates that VSG shunts reduce the need for daily CSF aspiration compared with VADs. Strength of Recommendation: Level II, moderate degree of clinical certainty. Recommendation Concerning Routine Use of Serial Lumbar Puncture: The routine use of serial lumbar puncture is not recommended to reduce the need for shunt placement or to avoid the progression of hydrocephalus in premature infants. Strength of Recommendation: Level I, high clinical certainty. Recommendation Concerning Nonsurgical Temporizing Agents: I. Intraventricular thrombolytic agents including tissue plasminogen activator (tPA), urokinase, or streptokinase are not recommended as methods to reduce the need for shunt placement in premature infants with PHH. Strength of Recommendation: Level I, high clinical certainty. Recommendation Concerning Nonsurgical Temporizing Agents. II. Acetazolamide and furosemide are not recommended as methods to reduce the need for shunt placement in premature infants with PHH. Strength of Recommendation: Level I, high clinical certainty. Recommendation Concerning Timing of Shunt Placement: There is insufficient evidence to recommend a specific weight or CSF parameter to direct the timing of shunt placement in premature infants with PHH. Clinical judgment is required. Strength of Recommendation: Level III, unclear clinical certainty. Recommendation Concerning Endoscopic Third Ventriculostomy: There is insufficient evidence to recommend the use of endoscopic third ventriculostomy (ETV) in premature infants with posthemorrhagic hydrocephalus. Strength of Recommendation: Level III, unclear clinical certainty.

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Section: Nonsurgical Temporizing Agentscontrasting

confidence: 93%

Section: Nonsurgical Temporizing Agentsmentioning

confidence: 97%

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants

ChouDhri

Limbrick

2014

PED

150

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“…This smaller group of patients generally has a poorer neurodevelopmental outcome than either healthy controls or IVH patients who did not undergo shunt insertion [25, 26]. Nevertheless, aggressive measures to prevent the development of hydrocephalus after IVH including drainage, irrigation and fibrinolytic therapy provided no benefit in either the frequency of shunt surgery or the overall mortality [27]. Neurological outcome expectedly depends on the severity of IVH, with lesser dependence on birth weight and gestational age [28], though the long-term functional status of these patients remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Functional Outcomes among Premature Infants with Intraventricular Hemorrhage

et al. 2009

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Objective: This work evaluated the mortality and functional outcomes of premature infants sustaining intraventricular hemorrhage (IVH). These outcomes were analyzed for their association with IVH severity, development of hydrocephalus and need for ventriculoperitoneal (VP) shunt insertion. Methods: A retrospective review was performed of neonates at the Children’s Hospital of Eastern Ontario who sustained IVH (1989–2005). Logistic regression tested demographic predictors of IVH severity, development of hydrocephalus and mortality. χ² analysis differentiated functional outcomes and mortality by IVH grade, development of hydrocephalus and intervention for cerebrospinal fluid diversion. All analyses used the 0.05 significance level. Results: Data were available for 284 patients with an average follow-up of 5.1 years. These were distributed as grade I (n = 135), grade II (n = 52), grade III (n = 43) and grade IV (n = 54), with lower gestational age and birth weight predicting disease severity. Hydrocephalus developed in 21% of patients, of whom 39% required VP shunt insertion. Overall mortality of 20% depended on IVH grade and was highest for grade IV patients (59%). Functional independence diminished with IVH severity, and patients with hydrocephalus fared worse than those without this sequel. Outcomes of patients developing hydrocephalus were similar whether or not they eventually required VP shunt insertion. Conclusions: This study describes a large cohort of neonatal IVH, describing how disease severity affects mortality and functional outcome. The overall mortality of nearly 1 in 5 patients is primarily of grade IV patients, with no difference between grade II and grade III. Further, patients surviving their hydrocephalus exhibited no worse functional deterioration if they required surgical intervention.

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“…They hope that therapy is going to reduce in antifibrolitic therapy to reduce the clot and normalizing the circulation of cerebrospinal fluid (18,54). Whitelaw opposes the use of streptokinase in infants with IVH (52). Therefore it remains as the basis of the surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment problems of hydrocephalus caused by spontaneus intraventricular hemorrhage in prematurely born children

Mihajlovic

Bogosavljevic²,

Nikolić³

et al. 2013

Turkish Neurosurgery

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AIm:The aim of this study was to identify the most appropriate method of surgical treatment of hydrocephalus in preterm infants that is caused by spontaneous intraventricular hemorrhage (IVH) and to identify predictive factors of poor perioperative outcomes. mAteRIAl and methods:We present a series of 60 patients with IVH and hydrocephalus, to whom a VP shunt or subcutaneous (Omaya) reservoir was placed, during the period from March 2006 to March 2011. Results ConClusIon:The outcome of hydrocephalus caused by IVH in premature born children is the worst in perinatology. Our results suggest that the main predictive factor is preoperative condition of the child and that the VP shunt and Omaya reservoir are complementary methods of surgical treatment. sonuÇ: Prematüre çocuklarda intraventriküler kanama nedeniyle oluşan hidrosefalinin sonuçları perinatoloji hastalıkları arasında en kötülerinden biridir. Sonuçlarımız ana prediktif faktörün çocuğun preoperatif durumu olduğunu ve VP şant ve Omaya rezervuarının tamamlayıcı cerrahi tedavi yöntemleri olduğunu göstermektedir.

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Randomized Clinical Trial of Prevention of Hydrocephalus After Intraventricular Hemorrhage in Preterm Infants: Brain-Washing Versus Tapping Fluid

Cited by 152 publications

References 23 publications

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants

Functional Outcomes among Premature Infants with Intraventricular Hemorrhage

Surgical treatment problems of hydrocephalus caused by spontaneus intraventricular hemorrhage in prematurely born children

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